P532 Cases of visceral leishmaniasis in a tertiary hospital in Athens, Greece

S118 heterogeneity of impacts more temporal and spatial specific research is needed. This opens further investigations in the area related to forecasting and monitoring systems in public health systems to prevent and control earlierly this emergent infectious disease. P531 Visceral leishmaniasis – does antimony loose its efficiency? G. Stevanovic, M. Pelemis, M. Pavlovic, J. Poluga, L. Lavadinovic (Belgrade, RS) Visceral leishmaniasis is parasitic diseases caused by Leishmania donovani (L. infantum, L. chagasi). Reservoirs of the parasites in our region are mostly dogs and rodents. Vector of transmission is sandflies. Illness was sporadically occurred in the southern regions of our country. Objective: The objective of this paper was to present our experience in treatment of visceral leishmaniasis and problems in unresponsiveness to antimony therapy. Method: During four years period in our department we treated 22 patients safer from visceral leishmaniasis. All the patients were citizens of Serbia and Montenegro. In endemic regions of these countries, live 18 patients, others were been during summer period in these regions. No one was traveled out of Europe. Results: All the patients were adults, average age of 40.24 (range from 22−78) years, 15 of them was mails and 7 were females. Medium duration of the illness before treatment was longer then 4 mounts. Most of them had fever, anaemia or pancytopenia and enlargement of liver and spleen. Diagnosis was established by serological methods and definitive diagnosis was done by microscopic examination of bone marrow smears. As a primary therapy we used antimony (Glukantime® ) in the doses of 20 mg/kg during 21−28 days. In one patient we used Pentostam® . Good outcome we have in 17 patients. But in 5 patients in spite of therapy, clinical findings were present. Spelnohepatomegaly was persisted, with pancytopenia. In patients with persistent findings of parasites we repeated therapy with antimony compounds. One of patient had good outcome, but other 4 were needed Amphothericin B. All of them were treated during 15−28 days, given intravenously for a total dose of 20 mg/kg. After two courses of Amphothericin B therapy, only two patients had persisted clinical findings longer then 6 months. These two patients were treated with liposomal amphotericin B (Ambisome® ) in daily dose of 2 mg/kg during 5 days. Resolution of the symptoms was achieved during first month after the therapy. Conclusions: Unresponsiveness to antimony therapy is becoming problem in Asia. In former Yugoslavia, we did not have such problems until now. That was first cases of visceral leishmaniasis that was unresponsive to antimony therapy in Serbia. Favourite outcome was achieved by use of liposomal amphothericin B.

17th ECCMID / 25th ICC, Posters four were native Greeks. Three of them were living in Attica area and two in urban areas of central Greece. All patients experienced symptoms for more than one month. Fever and hepatosplenomegaly were observed in all of the patients. The most frequent haematological finding was thrombocytopenia, leukopenia and anaemia. One patient found to have an underlying autoimmune disease. All patients were treated with liposomal amphotericin B and responded well. No adverse effects were detected. Conclusions: Visceral leishmaniasis should be included in the differential diagnosis of fever of unknown origin, especially in endemic regions like Greece. Early diagnosis leads to more effective treatment, preventing relapses and adverse effects. P533 Visceral leishmaniasis cases in Romania S. Florescu, C. Popescu, M. Cotiga, L. Raduta, R. Botgros, C. Voinea, S. Erscoiu, E. Ceausu, P. Calistru (Bucharest, RO) Background: Tropical diseases are no longer found only between 15 degrees northern and 15 degrees southern latitude. Increasing travelling all around the globe made possible the import of the tropical diseases in the temperate and cold weather regions. In such regions, the diagnosis of tropical diseases takes longer and is more difficult, especially in the visceral leishmaniasis. Objectives: We analysed the clinical features, the diagnosis tools and the treatment of the imported visceral leishmaniasis in Romania. Methods: retrospective study of 5 cases of visceral leishmaniasis admitted between 1999–2006 in the Clinic of Infectious and Tropical Diseases “Dr. V. Babes”. Results: All patients were males, with age limits between 22−35 years. They aquired the disease working in open spaces, in agriculture and building during 3 to 12 months; 2 of them worked in Spain, 2 in Italy and 1 in Greece. The period between the clinical onset and the positive diagnosis ranged from 2 to 14 months, wereas the period between the first medical consult and the positive diagnosis ranged from 2 weeks to 12 months. All patients had fever, chills, malaise, loss of apetite, weight loss from 6 to 20 kgs, liver and splenic enlargement and pancytopenia. Parasitological exam of the medular aspirate showed amastigote forms of Leishmania spp. and was the standard for positive diagnosis. Ethiological treatment consisted of Amfotericin (4 patients) and Pentamidin (1 patient). All patients survived. Conclusions: Visceral leishmaniasis is a reemergent disease in Romania, due to the masive immigration of the romanian workers, especially in the mediteraneen region. The positive diagnosis is usually delayed because the clinical aspect in nonspecific and aparrently sugests a haematological malignancy; thus, clinician must be aware of the epidemiological data, and mainly about the previous travels of the patient.

P532 Cases of visceral leishmaniasis in a tertiary hospital in Athens, Greece

P534 Recurrent cutaneous leishmaniasis due to Leishmania (Viannia) guyanensis after treatment with pentamidine: a study of 7 cases and analysis of this nosological entity

P. Karabogia, K. Ziva, M. Orfanidou, E. Sideris, M. Karanika, H. Malamou-Lada (Athens, GR)

J.P. Gangneux, S. Sauzet, S. Donnard, N. Meyer, A. Cornillet, F. Pratlong, C. Guiguen (Rennes, Saint-Aubin du Cormier, Montpellier, FR)

Objectives: The aim of this study was to report cases of visceral leishmaniasis in adults with emphasis to epidemiological features and response to treatment in a tertiary hospital in Athens, Greece, during the period 1/2005−10/2006. Methods: During the study period, 89 patients with high fever of unknown origin were admitted to the hospital. All of them underwent serology testing for CMV, EBV, Rickettsiae, Coxiella burnetii, Legionella, Brucella and Leishmania. Antibodies to Leishmania were detected from serum by an indirect immunofluorescence method (IFA, bioM´erieux) and the parasites were detected by direct microscopy of bone marrow smears. Results: Five out of 89 patients presented high titers of antibodies to Leishmania infantum (1/640−1/1280). Direct Giemsa stain of bone marrow smears indicated Leishmania parasites in four out of five of these patients. The patients median age was 55 years (range 16−80 years, two female-five male). One male patient was immigrant from Albania and

Introduction: Localised cutaneous leishmaniasis (CL) is the most common clinical expression of Leishmania infection in the New World. However, various clinical presentations with therapeutic difficulties and poorer prognosis exist: mucocutaneous leishmaniasis mainly due to L. braziliensis, and diffuse cutaneous leishmaniasis due to L. mexicana and L. amazonensis. Leishmaniasis recidivans is an unusual clinical Old World pattern mostly associated with L. tropica. Recurrence of CL lesions previously cured is also found in the New World CL, for which a few authors identified a specific nosological form, known as leishmaniasis recidiva cutis (LRC) and less than 30 cases have been reported. Objectives: Here, we report 7 cases of recurrent CL from French Guiana after treatment with pentamidine, and discuss this atypical clinical presentation. Results: For 15 days, French military personnels spent 3 months in French Guiana and took part in a training programme in the rainforest